Postgraduate Medical Journal[JOURNAL]
Sun
200 papers
Correction to: Early pregnancy maternal hemoglobin and the risk of neonatal congenital heart disease: insights from a case-control study, Guangdong, China.
Postgrad Med J · 2026 Feb · PMID 41403314 · Publisher ↗
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Opioid induced constipation: mechanisms and management.
Becker E, Madi MY, Magee M … +5 more , Ansari N, Ruffle JK, Syn WK, Drewes AM, Farmer AD
Postgrad Med J · 2026 Mar · PMID 41396728 · Publisher ↗
Opioid-induced constipation (OIC), a prevalent form of opioid-induced bowel dysfunction, significantly affects patients with chronic pain, both with and without cancer, who rely on opioid analgesics. OIC reduces opioid e...
Opioid-induced constipation (OIC), a prevalent form of opioid-induced bowel dysfunction, significantly affects patients with chronic pain, both with and without cancer, who rely on opioid analgesics. OIC reduces opioid effectiveness, impairs quality of life and is frequently underdiagnosed and inadequately managed. A comprehensive literature search of MEDLINE and EMBASE (2000-April 2025) was conducted using terms such as opioid-induced constipation, epidemiology, pathophysiology, treatment, and guidelines. Relevant studies, meta-analyses, and consensus statements were analysed to synthesize mechanistic insights and practical recommendations. This review clarifies OIC's pathophysiology, clinical evaluation, and evidence-based management strategies to guide practicing clinicians. OIC arises from opioids binding to mu-opioid receptors in the gastrointestinal tract, leading to slowed intestinal motility, reduced mucosal secretions, and increased sphincter tone, which collectively cause constipation and related symptoms. Clinicians should proactively educate patients about OIC risks at the start of opioid therapy or during dose escalation. Initial management includes prescribing over-the-counter laxatives, such as stimulant or osmotic agents, tailored to patient needs and tolerances. Regular follow-up, utilizing validated tools like the Bowel Function Index, is crucial to monitor symptom severity and adjust therapies as needed. If initial treatments fail, peripherally acting mu-opioid receptor antagonists are effective second-line options, yet they remain underutilized due to access barriers and low clinician awareness. Unlike prior reviews that primarily address pharmacologic mechanisms, this review integrates mechanistic insights with pragmatic clinical guidance, emphasizing evidence-based implementation strategies and global prescribing disparities to enhance real-world management of OIC.
Green tea consumption is associated with lower risk of sarcopenia in Chinese community-dwelling older adults.
Mao EH, Chang CL, Xu F … +5 more , Chen J, Lu X, Xu JS, Shen ZK, Gao W
Postgrad Med J · 2026 May · PMID 41385307 · Publisher ↗
BACKGROUND: Sarcopenia is an age-related progressive disease characterized by loss of muscle mass accompanied with low muscle strength and/or physical performance. The aim of the present study was to investigate the rela...
BACKGROUND: Sarcopenia is an age-related progressive disease characterized by loss of muscle mass accompanied with low muscle strength and/or physical performance. The aim of the present study was to investigate the relationship between green tea intake and sarcopenia in a Chinese population of community-dwelling older adults. METHODS: A cross-sectional retrospective study with 2553 participants aged ≥65 years was performed. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were measured to assess sarcopenia. A quantitative questionnaire was used to obtain information of green tea consumption. RESULTS: Sarcopenia group had lower proportion of green tea consumers when compared to the non-sarcopenia group (21.6% vs. 28.1%, P = .001). Multivariate logistic regression analysis showed that green tea intake was associated with decreased risk of sarcopenia (OR = 0.695, 95% CI = 0.547-0.882, P = .003). Subgroup analysis demonstrated that the association of green tea intake with sarcopenia was significant in individuals who drank a small amount (<125 g/month) and weak tea. Moreover, green tea consumers had higher ASMI and faster gait speed than non-green tea consumers. CONCLUSIONS: Our results suggest that green tea intake is associated with decreased risk of sarcopenia in a Chinese population of older adults, especially for those who prefer weak tea. Key messages What is already known on this topic: Although in vitro and in vivo studies have shown the protective effects of polyphenols on aging-related muscle loss and muscle dysfunction; however, the relationship between green tea consumption and the risk of sarcopenia remains unclear. What this study adds: Our findings demonstrate that green tea consumers had higher appendicular skeletal muscle mass index and faster gait speed than non-green tea consumers. Moreover, green tea consumption is associated with lower risk of sarcopenia in the older adults, especially for those who prefer weak tea. How this study might affect research, practice or policy: Our results suggest that drinking proper amount of green tea might be a health-promoting lifestyle for the prevention of sarcopenia in the older adults.
Genetic evidence for causal effects of lifestyle factors, psychiatric factors, and socioeconomic status on various spinal disorders.
Shao J, Xu S, Zhang H … +2 more , Meng H, Fei Q
Postgrad Med J · 2026 May · PMID 41385285 · Publisher ↗
PURPOSE: The main objective of this study was to investigate the causal association between genetic susceptibility of lifestyle, psychosocial factors, socioeconomic status, and various spinal disorders by using bidirecti...
PURPOSE: The main objective of this study was to investigate the causal association between genetic susceptibility of lifestyle, psychosocial factors, socioeconomic status, and various spinal disorders by using bidirectional Mendelian randomization (MR). MATERIALS AND METHODS: We used a bidirectional MR analysis to explore the association between 28 lifestyle, psychosocial factors, socioeconomic status, and a wide range of spinal disorders. We primarily adopted the inverse variance weighting method as the main effect estimate and used additional methods to evaluate the reliability of the results. RESULTS: Genetically predicted smoking and alcohol intake increased the risks of cervical spondylosis and intervertebral disc degenerative disease (IVDD). Longer education was associated with reduced risks of cervical spondylosis, IVDD, spinal stenosis, and spondylolisthesis/spondylolysis. Time spent watching TV increased the risks of cervical spondylosis, IVDD, and spinal stenosis. Sleeplessness elevated the risks of spinal stenosis and IVDD. Higher Townsend deprivation index was linked to cervical spondylosis and spondylolisthesis/spondylolysis, while neuroticism and higher household income increased IVDD risk. Depression was associated with cervical spondylosis. Sensitivity and reverse MR analyses supported robust and unidirectional causal relationships. CONCLUSION: The results of the study emphasize the importance of addressing certain modifiable risk factors to reduce the burden of spinal diseases and improve the health status of the population. Key messages What is already known on this topic: Several retrospective and epidemiological studies have demonstrated associations between certain lifestyle, psychiatric, socioeconomic factors, and the risk of developing spinal disorders. However, there are no studies that have verified a positive causal relationship between these associations. What this study adds: This study employed a rigorous Mendelian randomization strategy to confirm and quantify the causal effects of known risk factors, thereby confirming the directionality of causality. How this study might affect research, practice, or policy: This study provides a scientific foundation for developing precise prevention strategies and public health policies targeting modifiable risk factors.
HMGCR-related SNPs and cholelithiasis: statins may exert effects beyond lipid-lowering.
Qin D, Wei Q, Du S
Postgrad Med J · 2026 May · PMID 41378867 · Publisher ↗
BACKGROUND: As traditional lipid-lowering drugs, the role of statins in reducing the incidence of cholelithiasis remains controversial. The aim of this study is to utilize the single nucleotide polymorphisms (SNPs) relat...
BACKGROUND: As traditional lipid-lowering drugs, the role of statins in reducing the incidence of cholelithiasis remains controversial. The aim of this study is to utilize the single nucleotide polymorphisms (SNPs) related to the target of statins, HMGCR, to simulate the effect of statins and explore the causal relationship between statins and cholelithiasis. METHODS: Drug-targeted Mendelian randomization (MR) was first applied to study the causal relationship between the application of statins and the risk of cholelithiasis. Subsequently, we explored the causal relationship between other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors and the incidence of cholelithiasis. Thereafter two-sample MR analyses were conducted to examine the associations of lipids with the risk of cholelithiasis. RESULTS: The Low-Density Lipoprotein Cholesterol (LDL-C)-reducing SNPs near the HMGCR gene (rs10066707, rs12916, rs2006760, rs5909, and rs2303152), which mimic the effects of statins, were associated with a decreased risk of cholelithiasis (OR 0.445, 95% CI 0.339-0.585, P < 0.001). However, other lipid-lowering drugs such as ezetimibe and PCSK9 inhibitors, when reducing the same level of LDL-C, cannot reduce the incidence of cholelithiasis. Moreover, multivariable MR analyses showed that neither LDL-C nor High-Density Lipoprotein Cholesterol (HDL-C) had a significant impact on cholelithiasis risk. CONCLUSION: These facts shows that statins are associated with a decreased risk of cholelithiasis, and this association is unlikely to be mediated by lipid-lowering effects. Further clinical trials and basic experimental validation is needed to validate their relationship and underlying mechanisms.
Association between albumin-to-neutrophil-lymphocyte ratio and all-cause and cardiovascular mortality in the general population: a cohort study.
Chen L, Yao H, Liu Y … +3 more , Dai Z, Song Y, Wang Z
Postgrad Med J · 2026 May · PMID 41378859 · Publisher ↗
BACKGROUND: Albumin-to-neutrophil-lymphocyte ratio (ANLR) is a novel composite biomarker integrating nutritional and inflammatory status. However, its prognostic value for mortality in the general population remains uncl...
BACKGROUND: Albumin-to-neutrophil-lymphocyte ratio (ANLR) is a novel composite biomarker integrating nutritional and inflammatory status. However, its prognostic value for mortality in the general population remains unclear. This study aimed to evaluate the predictive utility of ANLR for all-cause and cardiovascular mortality. METHODS: This study included 36 628 adults from the National Health and Nutrition Examination Survey 2003-2018. Mortality details were ascertained from the National Death Index. The relationship between ANLR and all-cause and cardiovascular mortality was verified using restricted cubic spline (RCS), weighted Cox proportional hazards model, subgroup analysis and time-dependent receiver operating characteristic curve (ROC). RESULTS: RCS analysis revealed an L-shaped ANLR-mortality relationship with an inflection point at 2.19. Below this threshold, each 0.1-unit ANLR increase was associated with 5.0% lower all-cause mortality (HR 0.95, 95% CI 0.94-0.96) and 6.0% lower cardiovascular mortality (HR 0.94, 95% CI 0.92-0.96). Participants were stratified into higher (> 1.23) and lower (≤ 1.23) ANLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher ANLR had a significantly reduced risk of all-cause (HR 0.57, 95% CI 0.53-0.62) and cardiovascular mortality (HR 0.55, 95% CI 0.47-0.65). Results were consistent across subgroups. Time-dependent ROC analysis confirmed moderate predictive ability over 1-7 years, with area under the curve values of 0.667-0.708 for all-cause and 0.690-0.703 for cardiovascular mortality. CONCLUSION: Elevated ANLR is associated with reduced mortality risk, though non-linearly. Clinical attention to albumin supplementation and maintaining appropriate neutrophil-to-lymphocyte ratio levels may be warranted in high-risk populations.
Vulnerable patient groups in the Emergency Department: association with hospitalization, Intensive Care Unit admission, and mortality.
Hilpert F, Riedel HB, Bingisser R … +2 more , Nickel CH, Espejo T
Postgrad Med J · 2026 May · PMID 41378858 · Publisher ↗
BACKGROUND: While triage systems focus on clinical acuity, patients at risk due to underlying vulnerabilities may be overlooked. Identifying specific vulnerability markers at triage could enhance early risk stratificatio...
BACKGROUND: While triage systems focus on clinical acuity, patients at risk due to underlying vulnerabilities may be overlooked. Identifying specific vulnerability markers at triage could enhance early risk stratification. This study investigates the association between predefined vulnerability markers and adverse outcomes in emergency department patients, independently of triage level and presenting complaint. METHODS: Prospective study of an all-comer population presenting to the emergency department of a tertiary care hospital. The patients were attributed to one or more vulnerable groups at triage. RESULTS: Among the 4191 included patients, several vulnerability markers were associated with adverse outcomes after adjustment for age and sex. Patients with cognitive impairment had significantly higher odds of 30-day mortality [odds ratio (OR) 2.24; 95% confidence interval (CI), 1.08-4.32]. Intensive care unit admission was more likely in patients with immunosuppression (OR 4.13; 95% CI, 2.14-7.40), substance use disorder (OR 1.82; 95% CI, 1.03-3.02), and diabetes (OR 1.73; 95% CI, 1.07-2.71). Hospital admission was associated with cognitive impairment, immunosuppression, substance use disorder, diabetes, recent surgical intervention, and psychiatric comorbidities. In contrast, no significant associations with adverse outcomes were found for those with medical devices, acutely intoxicated patients, pregnancy, migrant status, or patients with recent trauma. CONCLUSIONS: Certain vulnerability markers identifiable at triage are associated with specific adverse outcomes. These findings highlight the potential of pragmatic, early vulnerability assessment to improve risk stratification in the emergency department.
Teaching diagnostic safety: moving beyond differential lists in postgraduate training.
Jerjes W
Postgrad Med J · 2025 Dec · PMID 41359438 · Publisher ↗
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Navigating UK cardiology higher specialty training applications: a practical guide.
Matthews C, Brown OI, Lawson L … +7 more , Khalid S, Morgan H, Straw S, Sengupta A, Gosai J, Cubbon R, Drozd M
Postgrad Med J · 2025 Dec · PMID 41359435 · Publisher ↗
Cardiology remains one of the most competitive medical specialties in the UK. This article provides practical guidance for aspiring cardiologists preparing for Higher Specialty Training applications. It outlines strategi...
Cardiology remains one of the most competitive medical specialties in the UK. This article provides practical guidance for aspiring cardiologists preparing for Higher Specialty Training applications. It outlines strategies to maximize portfolio scores, prepare effectively for interviews and adapt to recent changes in the scoring framework. The guidance also simultaneously supports the development of core skills essential for a successful career in cardiology.
Postgraduate Medical Journal, the early years.
Elte JWF, Vale JA, Cheung BMY
Postgrad Med J · 2026 May · PMID 41327759 · Publisher ↗
Abstract loading — click title to view on PubMed.
Correction to: Dose-dependent association between proton pump inhibitor use and the risk of migraine: a nationwide matched case-control study.
Postgrad Med J · 2026 Feb · PMID 41325096 · Publisher ↗
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The early years: some tips for clinicians in training.
Welsby PD
Postgrad Med J · 2025 Dec · PMID 41324491 · Publisher ↗
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Effect of physical activity volume on all-cause mortality in patients with cardiovascular-kidney-metabolic syndrome: evidence from the China health and retirement longitudinal study.
Fu X, Sun W, Zhang Z … +3 more , Gao J, Guo M, Wang R
Postgrad Med J · 2026 Apr · PMID 41317005 · Publisher ↗
BACKGROUND: Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease, cardiovascular disease, and metabolic disorders. Although physical activity is widely acknowl...
BACKGROUND: Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease, cardiovascular disease, and metabolic disorders. Although physical activity is widely acknowledged as an effective intervention for improving the prognosis of chronic diseases, its impact on all-cause mortality among patients with CKM syndrome remains unclear. OBJECTIVE: To investigate the impact of physical activity on all-cause mortality among patients with CKM syndrome. METHOD: Data from the 2011 wave of the China Health and Retirement Longitudinal Study were used as the baseline, with follow-up conducted until 2013. According to the International Physical Activity Questionnaire criteria, weekly physical activity levels were divided into three categories: light-volume physical activity (LPA), moderate-volume physical activity (MPA), and vigorous-volume physical activity (VPA). Cox proportional hazards regression models were employed to assess the impact of varying levels of physical activity on all-cause mortality. Restricted cubic spline analysis was used to explore possible nonlinear relationships. RESULTS: A total of 3343 patients with CKM syndrome were enrolled in this study. During the 2-year follow-up period, 44 deaths were recorded. After adjusting for potential confounders, VPA was associated with a 54% lower risk of all-cause mortality (adjusted hazard ratios, 0.46; 95% confidence interval: 0.24-0.89). Dose-response relationships demonstrated that all-cause mortality decreased as physical activity increased, with a 5.8% reduction in all-cause mortality risk for every 1000 MET-min/week increment in physical activity levels. CONCLUSIONS: VPA was significantly associated with reduced all-cause mortality in patients with CKM syndrome. Encouraging patients with CKM syndrome to engage in increased physical activity may improve clinical outcomes. Key messages What is already known on this topic: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves a complex interplay between cardiovascular disease, metabolic disorders, and chronic kidney disease. While prior studies have established that physical activity can decrease mortality risk in the general population as well as in patients with cardiovascular and metabolic syndromes, the evidence regarding its impact on individuals with CKM syndrome remains limited. Additionally, there is a lack of detailed dose-response analyses of physical activity specifically targeting this high-risk population. What this study adds: This study provides novel evidence indicating that vigorous-volume physical activity (>3000 MET-minutes/week) significantly decreases all-cause mortality by 54% among patients with CKM syndrome, whereas moderate-volume, and light-volume physical activities show no significant effects. Notably, a linear dose-response relationship was established, demonstrating that each 1000-MET increment corresponds to a 5.8% reduction in mortality risk. These findings address a critical knowledge gap by quantifying both the threshold and incremental benefits of physical activity specifically for individuals with CKM syndrome, a population characterized by unique multisystem pathophysiology. How this study might affect research, practice, or policy: The findings of this study have the potential to substantially impact clinical practice by offering evidence-based thresholds for physical activity recommendations in the management of CKM syndrome. The benefits associated with vigorous-volume physical activity (>3000 MET-minutes/week) may encourage guideline committees to formulate more precise exercise prescriptions tailored to this high-risk population. Additionally, these results can be incorporated into a multidisciplinary care framework designed for managing complex chronic conditions.
Exploring the effect of a culturally adapted and personalized digital CBT-I app in insomnia patients with mild-to-moderate OSA: a secondary analysis of a randomized controlled trial.
Zhang C, Liu Y, Guo X … +2 more , Shen Y, Ma J
Postgrad Med J · 2026 Apr · PMID 41307552 · Publisher ↗
BACKGROUND: This study aimed to evaluate the effectiveness of a culturally adapted, interactive, and personalized digital cognitive behavioral therapy (CBT-I) for individuals with co-morbid insomnia and sleep apnea (COMI...
BACKGROUND: This study aimed to evaluate the effectiveness of a culturally adapted, interactive, and personalized digital cognitive behavioral therapy (CBT-I) for individuals with co-morbid insomnia and sleep apnea (COMISA), and to compare the treatment outcomes with those of insomnia alone. METHODS: This secondary analysis utilized data from a prior randomized controlled trial. The efficacy of digital CBT-I (dCBT-I) on insomnia severity and mental health was assessed in both COMISA and insomnia-only groups at postintervention and at 1-, 3-, and 6-month follow-ups. RESULTS: Among 38 insomnia participants who completed the dCBT-I, 20 underwent sleep studies (4 males, 16 females; mean age 52.3 ± 13.0 years). Seven were diagnosed as mild-to-moderate obstructive sleep apnea (COMISA), and 13 did not (insomnia alone). Compared with baseline, the insomnia severity index scores significantly decreased at postintervention and the 1-, 3-, and 6-month follow-ups in both the COMISA and insomnia alone groups (P < .05), with large effect sizes (Cohen's d > 1.0). No significant differences were observed between the two groups in insomnia severity index scores at baseline, postintervention, and at 1-, 3-, and 6-month follow-ups (P > .05). Mixed-effects models indicated no significant group × time interaction on insomnia severity index scores (P > .05). Wake time after sleep onset, sleep efficiency of the sleep diaries, and health questionnaire (PHQ-9) scores also improved significantly postintervention and at follow-up in both groups. CONCLUSIONS: This self-guided, culturally adapted, and personalized dCBT-I effectively improved insomnia severity, sleep quality, and depressive symptoms among individuals with COMISA. While treatment effects were comparable between COMISA and insomnia-alone groups, the observed numerical differences may reflect limited statistical power. Larger studies are warranted to determine whether individuals with comorbid obstructive sleep apnea respond differently to dCBT-I. Key messages What is already known on this topic: Cognitive behavioral therapy for insomnia may improve outcomes in patients with comorbid insomnia and sleep apnea. What this study adds: This study shows that an interactive, personalized, and culturally adapted digital cognitive behavioral therapy for insomnia program is also effective for comorbid insomnia and sleep apnea patients. How this study might affect research, practice, or policy: These findings support broader implementation of tailored digital cognitive behavioral therapy for insomnia in the treatment of comorbid insomnia and sleep apnea.
Understanding the perceptions of female genital mutilation among future healthcare professionals in Egypt's Northern Nile delta (understanding female genital cutting among students).
Kabbash IA, Salama B, Abada MA … +2 more , Mogahed MA, Elghazally NM
Postgrad Med J · 2026 Apr · PMID 41269161 · Publisher ↗
BACKGROUND: Female genital mutilation (FGM) is still a prevalent practice in Egypt. Healthcare workers (HCWs) are often involved in performing the FGM procedure. Understanding FGM-related attitudes can help prevent this...
BACKGROUND: Female genital mutilation (FGM) is still a prevalent practice in Egypt. Healthcare workers (HCWs) are often involved in performing the FGM procedure. Understanding FGM-related attitudes can help prevent this harmful practice. OBJECTIVE: To assess knowledge and attitudes of medical students about FGM. METHODS: A cross-sectional study recruiting 560 medical students using a structured self-administered questionnaire for data collection. RESULTS: Females represented 59.5% and those of urban residence represented 54.5%. FGM was accepted by 30% of males compared to 22.2% of females with a significant odds ratio of 1.497 (95% CI = 1.020-2.197). Participants from rural areas (OR = 1.809, 95% CI: 1.232-2.658) and those whose fathers (OR = 2.509, CI = 1.685-3.738) and mothers (OR = 2.422, 95% CI = 1.643-3.571) lacked university education showed significantly higher acceptance of FGM. Medical students cited religion (89.1%) and female chastity (84.5%) as the main reasons for supporting FGM. They rejected the practice primarily due to the risk of serious complications (67.7%) and the belief that it is a harmful social custom (63.4%). A total of 88% of participants reported knowing the long-term consequences of FGM, including psychological trauma (63.2%), reduced sexual pleasure (38.8%), and marital problems (23.2%). Among participants, 48.2% reported that FGM violates the law, 20.9% believed religion supports it, and 15.4% supported its continuation. CONCLUSION: Medical students showed a considerable acceptance of FGM, which was affected by gender, residence, and parental education. Participants had good knowledge about its negative consequences, but they still had a positive attitude towards it. Key messages Egypt has one of the highest global prevalence rates of FGM despite its criminalization in 2008. A significant proportion of cases are performed by healthcare professionals. This study explores the underlying cultural, religious, and social factors that shape the perceptions of future physicians, whose views may directly impact the continuation or prevention of FGM. Results will support targeted awareness campaigns for young healthcare professionals.
NRMP couples match outcomes for internal medicine residents.
Diaz A, Singh A, Bujnowski D … +1 more , Farnan J
Postgrad Med J · 2026 Apr · PMID 41263777 · Publisher ↗
BACKGROUND: The National Residency Match Program considers a successful Couples Match when both parties match, regardless of location. However, there is a dearth of data on Couples Match outcomes compared to normal Match...
BACKGROUND: The National Residency Match Program considers a successful Couples Match when both parties match, regardless of location. However, there is a dearth of data on Couples Match outcomes compared to normal Match Outcomes. OBJECTIVE: To compare the success rates, geographic preferences, and application preparation between Couples Match and traditional Match applicants within the specialty of internal medicine. METHODS: An anonymous, cross-sectional, two-part REDCap survey was designed for standard and Couples Match residents. This survey was distributed via email to 437 academic United States internal medicine program directors from 1 October 2022 to 31 December 2023. Questions focused on post-match satisfaction, pre-application priorities, and number of interviews conducted. Around 248 residents completed the survey across the 437 internal medicine residency programs initially contacted. RESULTS: 64% (52/82) of Couples Match participants felt the need to make compromises to ensure dual matching. Compared to standard applicants, Couples Match applicants were significantly less likely to match in their top three ranked programs (89% vs. 67%, P < 0.01). When asked how to rate their perceived stress during the match process on a scale of 1-10, Couples Match respondents reported significantly higher perceived stress than their standard match counterparts (7.85 ± 1.30 vs. 7.13 ± 1.74) (P < 0.001). CONCLUSIONS: We found that Couples Match applicants had differing pre-match priorities, significantly less likelihood of matching in their top three programs, and significantly higher perceived levels of stress. Our study highlights the unique needs and stressors of medical students who are applying to internal medicine through the Couples Match. Key messages What is already known on this topic: While the NRMP Couples Match boasts a high overall success rate, little is known about specialty-specific outcomes, applicant satisfaction, or the personal and professional compromises made by couples, particularly within internal medicine. What this study adds: This is the first national study to quantify internal medicine Couples Match outcomes, revealing that these applicants face significantly higher stress, are less likely to match at top-choice programs, and frequently compromise on prestige, geography, and personal priorities to match with their partner. How this study might affect research, practice, or policy: These insights underscore the need for tailored advising, informed program recruitment strategies, and potential policy considerations to better support the unique constraints faced by Couples Match applicants-enhancing both resident well-being and match satisfaction.
A greener pulse for cardiology: sustainability and clinical care in the NHS.
Sethi A, Gill JS, Gill JS
Postgrad Med J · 2025 Nov · PMID 41263776 · Publisher ↗
INTRODUCTION: Cardiovascular disease is one of the most common causes of mortality and morbidity in the UK and its ecological footprint makes a significant impact on the healthcare system overall. AREAS FOR IMPROVEMENT:...
INTRODUCTION: Cardiovascular disease is one of the most common causes of mortality and morbidity in the UK and its ecological footprint makes a significant impact on the healthcare system overall. AREAS FOR IMPROVEMENT: The NHS is one of the first national health system to commit to net-zero emissions by 2040, and exemplifies a growing global push toward sustainable healthcare. However, maintaining clinically safety and efficacious care is paramount, and balancing this with sustainability poses a challenge. While system-wide reforms require time and collaboration, many sustainable practices can be adopted immediately without affecting patient care. Ongoing research and robust data are necessary to support the safe integration of these environmentally conscious strategies into cardiovascular practice. FUTURE DIRECTION: This paper puts forward strategies that will enable sustainability and practical implementation at both an individual and departmental level, and a broader national level, with a focus on maintaining clinical standards.
Parental socioeconomic status and medical specialty choice: a nationwide analysis of Japanese physicians.
Sakaguchi K, Yamamoto H, Ohira Y … +5 more , Otsuka T, Yamasaki D, Tokuda Y, Shiraishi Y, Watari T
Postgrad Med J · 2026 Apr · PMID 41263772 · Publisher ↗
PURPOSE OF THE STUDY: Previous studies have suggested a potential link between parental socioeconomic status and medical specialty choice; however, empirical evidence from Japan remains scarce. Therefore, we aimed to inv...
PURPOSE OF THE STUDY: Previous studies have suggested a potential link between parental socioeconomic status and medical specialty choice; however, empirical evidence from Japan remains scarce. Therefore, we aimed to investigate the association between parental socioeconomic status and medical specialty choice in Japan. STUDY DESIGN: This nationwide cross-sectional online survey was conducted in June 2022 using "Nikkei Medical Online", a professional platform for physicians. Data on medical specialty choice and parental socioeconomic status indicators (household income, occupation, and birthplace) were collected. Parental socioeconomic status was dichotomized based on an annual household income threshold of US$60 000 (approximately Japanese Yen 10 million). Association was evaluated by multivariable logistic regression analysis. RESULTS: Of 3580 physicians included, 48.6% were from families with a parental household income of US$60000 or more. The proportion of physicians from high-income families was the highest in neurosurgery (65.8%) and dermatology (57.0%) and the lowest in radiology (30.8%), pathology (36.2%), and psychiatry (35.7%). Using multivariable analysis, choosing certain specialties was significantly associated with having a physician father (adjusted odds ratio, 14.46; 95% confidence interval, 12.10-17.29) and being born in an urban area (adjusted odds ratio, 1.65; 95% confidence interval, 1.41-1.92). CONCLUSIONS: This is the first study to quantitatively assess the significant association between parental socioeconomic status and medical specialty choice among physicians in Japan. Parental socioeconomic status appears to be a key factor in physicians' career choices. Future research should be more comprehensive and include multifaceted components of socioeconomic status and psychosocial factors. Key messages What is already known on this topic: Previous studies, primarily from Western countries, have suggested a potential link between socioeconomic status and physicians' specialty choice; however, empirical data from Japan are largely absent. What this study adds: This nationwide study in Japan revealed a significant association between specialty choice and parental factors, including high income and having a physician parent and urban birthplace. This highlights the fact that physicians from high-socioeconomic status backgrounds are disproportionately represented in certain specialties, such as neurosurgery and dermatology. How this study might affect research, practice or policy: Understanding the association between parental socioeconomic status and specialty choice could inform policy designs aimed to promote equitable career counseling and ensure a balanced distribution of the physician workforce across specialties.
Traumatic injuries in polo players.
Ken-Dror G, Chua V, Sharma P … +1 more , Hurlingham Polo Association Safety Committee
Postgrad Med J · 2026 Apr · PMID 41263769 · Publisher ↗
OBJECTIVE: To determine the frequency of traumatic injuries in polo players in England. METHODS: The survey included data on body location and reason for injury derived from accident reports using a retrospective cohort...
OBJECTIVE: To determine the frequency of traumatic injuries in polo players in England. METHODS: The survey included data on body location and reason for injury derived from accident reports using a retrospective cohort design from 26 participating English polo clubs between the years 2018 and 2024. RESULTS: The study population included injuries in 236 polo players. The most common injury site was the limb (arm, hand, leg, wrist, shoulder) 47.9% (95% CI: 41.4-54.5), and face or head 38.6% (95% CI: 32.3-45.1), of which 12.1% (95% CI: 6.2-20.6) affected the eyes. The most common reason to require hospital treatment was injury sustained to the eyes, 45.5% (95% CI: 16.7-76.6), followed by limb 36.9% (95% CI: 27.6-47.0), and face or head 35.4% (95% CI: 23.9-48.2) (proportional difference P = .006). The most common sites to suffer an injury by the ball or stick and require hospital treatment were the head or face, 38.1% (95% CI: 23.6-54.4), eyes, 37.5% (95% CI: 8.5-75.5), and limb, 19.2% (95% CI: 9.6-32.5) (proportional difference P ≤ .001). The most common injury requiring hospital treatment that involved the horse was to the eyes, 66.7% (95% CI: 1.0-91.0). There was a significant proportional difference for eye injuries caused by the horse requiring hospital treatment compared to face/head (57.7%, 95% CI: 28.8-86.6, P < .001) or limb injuries (58.9%, 95% CI: 30.3-87.7, P < .001). CONCLUSION: Traumatic injury to the eyes while playing polo is the most common reason for requiring hospital treatment. As the head is already protected by mandating helmet use, we now advise similar regulation for eye protection by directing the wearing of sports glasses, goggles, or face guards. Key messages What is already known on this topic: Polo is regarded as a high-risk sport, which may result in traumatic injuries, the most serious affecting the head. Wearing of helmets is required during play to reduce this risk. What this study adds: Traumatic eye injuries during play are common and sustained from either the stick, ball, or fall from the horse. While the head is reasonably protected with helmets, injuries to the eyes while playing polo are the most common reason for requiring hospital treatment. How this study might affect research, practice or policy: As helmets are already mandated while playing polo, we now advocate the compulsory use of eye protection (sports glasses, goggles or face guards) for all polo players.
AI's environmental impact: a critical gap in medical education.
Scholfield A
Postgrad Med J · 2025 Nov · PMID 41263760 · Publisher ↗
Abstract loading — click title to view on PubMed.
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